States' Purchasing Power Can Improve Substance Abuse Treatment Care

Promoting the use of evidence-based practice in substance abuse disorder treatment among states

On December 10, 2004, the Center for Health Care Strategies convened a meeting on the use by states of purchasing levers to support better implementation of evidence-based practices in the treatment of substance-use disorders.

States are the largest purchasers of treatment services and therefore will play a central role in improving treatment quality.

Key Results

  • The meeting explored:

    • Existing Models:
      • The initial Center for Health Care Strategies/Legal Action Center research concluded that there are few if any good models of the effective use by states of purchasing levers specifically to support evidence-based practices. However, a small number of states have begun to experiment with giving financial incentives for performance on certain indicators.
    • Potential Incentives to Promote the Use of Evidence-Based Practices:
      • States are using—or are exploring using—different types of incentives to promote the use of evidence-based practices in substance-use disorder treatment. Participants at the meeting described five such types:
      • Financial payments (pay-for-performance).
      • Relief from regulatory requirements.
      • Allowing an advantage in a competitive bidding process.
      • Providing infrastructure support (including free training in evidence-based practices).
      • Recognition for providing evidence-based care.
    • Challenges to the Use of Purchasing Levers:
      • There are four main categories of challenges to effective state use of evidence-based practice purchasing levers:
        1. leadership for change
        2. coordination and cooperation among providers
        3. financing
        4. training/technical assistance in the use of evidence-based practices.